Primary Contact Name *

Parent/guardian's name if enrolling a child, or your name if enrolling as a student

First Name

Last Name

Phone *

(###)

###

####

Preferred days *

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Preferred weekday times

9-11am

11-1pm

1-3pm

3-6pm

Preferred weekend times

9-11am

11-1pm

1-3pm

3-6pm

Pool Location *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Media & Social Media Consent

I CONSENT – I, or as the parent/guardian of the participant, allow Manta Splash LLC to take photos/videos of the participant for training, promotional, marketing, social media, or website use.

I DO NOT CONSENT – I, or as the parent/guardian of the participant, do not allow photos/videos. Lessons and services will not be affected.

Please review the Manta Splash LLC Liability Release, Assumption of Risks, and Policies at the end of the registration form *

By checking the box below, you confirm that you have read, understood, and agree to the terms

I confirm that I have read, understood, and agree to the updated Manta Splash LLC Liability Release, Assumption of Risks, and Policies.

Todays' Date *

MM

DD

YYYY